Selective cTACE to a segment target hepatocellular carcinoma lesion during atezolizumab plus bevacizumab therapy achieving delayed hypovascularization and shrinkage of non-target intrahepatic lesions: a case report.

Atezolizumab plus bevacizumab (Atez/Bev) is the standard first-line systemic therapy for unresectable hepatocellular carcinoma (HCC). We report HCC with intrahepatic progression during Atez/Bev in which selective conventional transarterial chemoembolization (cTACE) to a single lesion was followed by non-target lesion shrinkage. An 82-year-old woman with metabolic dysfunction-associated steatotic liver disease was diagnosed with BCLC stage B hepatocellular carcinoma in segments 5/7. After TACE, residual viable tumor persisted in segment 5, and Atez/Bev was initiated. After 4 cycles, a new intrahepatic lesion appeared in segment 8, and after 7 cycles, lesions in segments 5/7/8 enlarged, meeting the mRECIST progressive disease criteria. Systemic therapy continued, and selective cTACE for the segment 5 lesion was added. At 3 months post-cTACE, segment 5 viability decreased, but overall mRECIST remained progressive disease. At 6 months (November 20XX + 1), arterial enhancement in segment 5 resolved and non-target segment 7/8 lesions became hypovascular and shrank, achieving partial response.